| NPI | 1104526631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NM 4266) |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2026-08-25 |